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General NPI Number Information
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NPI Number | 1174615918
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN HAND CENTER, P.A.
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 6100 KENNERLY RD SUITE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4368
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Country | US
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Telephone | 904-733-5550
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Fax | 904-733-5515
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Provider Business Mailing Address
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Address Line | 6100 KENNERLY RD SUITE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4368
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Country | US
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Telephone | 904-733-5550
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Fax | 904-733-5515
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK LEELAND GREIDER JR.
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Credential | MD
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Telephone | 904-733-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | ME27693
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License Number State | FL
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